Utility of intraoperative cystoscopy in detecting ureteral injury during vaginal hysterectomy

Mallika Anand, Elizabeth C Evans, Christine A. Heisler, Amy L. Weaver, Bijan J. Borah, Amy E. Wagie, James P. Moriarty, John B. Gebhart

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives The aim of this study was to determine the utility of intraoperative cystoscopy in detecting and managing ureteral injury among women undergoing vaginal hysterectomy. Methods We performed a secondary analysis of a retrospective cohort study of 593 patients who underwent vaginal hysterectomy for benign indications, with or without additional pelvic floor reconstructive surgery, from January 2, 2004, through December 30, 2005. A logistic regression model determining the propensity to undergo intraoperative cystoscopy was constructed. Comparisons of ureteral injury and cost between patients with and without cystoscopy were adjusted for the cystoscopy propensity score. We further explored the feasibility of using perioperative change in creatinine level to detect ureteral injury. Results In total, 230 (38.8%) of 593 patients underwent cystoscopy. Six patients (2.6%) in the cystoscopy group and 5 (1.4%) in the no-cystoscopy group had ureteral injuries (odds ratio, 1.92; 95% confidence interval [CI], 0.58-6.36). This association was further attenuated after adjusting for the propensity to undergo cystoscopy (odds ratio, 1.31; 95% CI, 0.19-9.09). Four injuries detected cystoscopically were managed intraoperatively. Adjusted mean-predicted costs for patients undergoing cystoscopy were $10,686 (95% CI, $7500-$13,872) versus $10,217 (95% CI, $6894-$13,540). In the no-cystoscopy group, patients with ureteral injury had a median increase in creatinine level of 0.2 mg/dL, whereas patients without injury had a median decrease of 0.1 mg/dL (P < 0.001). Conclusions The level of selection for cystoscopy did not significantly increase the mean predicted costs for patients. Reliance on postoperative creatinine level to detect ureteral injury, while highly sensitive, is limited by a low positive predictive value and variable range.

Original languageEnglish (US)
Pages (from-to)70-76
Number of pages7
JournalFemale Pelvic Medicine and Reconstructive Surgery
Volume21
Issue number2
DOIs
StatePublished - Mar 10 2015

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Vaginal Hysterectomy
Cystoscopy
Wounds and Injuries
Confidence Intervals
Creatinine
Costs and Cost Analysis
Reconstructive Surgical Procedures
Logistic Models
Odds Ratio
Propensity Score
Pelvic Floor
Cohort Studies
Retrospective Studies

Keywords

  • genitourinary injury
  • screening cystoscopy
  • urogynecology

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Surgery
  • Urology

Cite this

Anand, M., Evans, E. C., Heisler, C. A., Weaver, A. L., Borah, B. J., Wagie, A. E., ... Gebhart, J. B. (2015). Utility of intraoperative cystoscopy in detecting ureteral injury during vaginal hysterectomy. Female Pelvic Medicine and Reconstructive Surgery, 21(2), 70-76. https://doi.org/10.1097/SPV.0000000000000157

Utility of intraoperative cystoscopy in detecting ureteral injury during vaginal hysterectomy. / Anand, Mallika; Evans, Elizabeth C; Heisler, Christine A.; Weaver, Amy L.; Borah, Bijan J.; Wagie, Amy E.; Moriarty, James P.; Gebhart, John B.

In: Female Pelvic Medicine and Reconstructive Surgery, Vol. 21, No. 2, 10.03.2015, p. 70-76.

Research output: Contribution to journalArticle

Anand, M, Evans, EC, Heisler, CA, Weaver, AL, Borah, BJ, Wagie, AE, Moriarty, JP & Gebhart, JB 2015, 'Utility of intraoperative cystoscopy in detecting ureteral injury during vaginal hysterectomy', Female Pelvic Medicine and Reconstructive Surgery, vol. 21, no. 2, pp. 70-76. https://doi.org/10.1097/SPV.0000000000000157
Anand, Mallika ; Evans, Elizabeth C ; Heisler, Christine A. ; Weaver, Amy L. ; Borah, Bijan J. ; Wagie, Amy E. ; Moriarty, James P. ; Gebhart, John B. / Utility of intraoperative cystoscopy in detecting ureteral injury during vaginal hysterectomy. In: Female Pelvic Medicine and Reconstructive Surgery. 2015 ; Vol. 21, No. 2. pp. 70-76.
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abstract = "Objectives The aim of this study was to determine the utility of intraoperative cystoscopy in detecting and managing ureteral injury among women undergoing vaginal hysterectomy. Methods We performed a secondary analysis of a retrospective cohort study of 593 patients who underwent vaginal hysterectomy for benign indications, with or without additional pelvic floor reconstructive surgery, from January 2, 2004, through December 30, 2005. A logistic regression model determining the propensity to undergo intraoperative cystoscopy was constructed. Comparisons of ureteral injury and cost between patients with and without cystoscopy were adjusted for the cystoscopy propensity score. We further explored the feasibility of using perioperative change in creatinine level to detect ureteral injury. Results In total, 230 (38.8{\%}) of 593 patients underwent cystoscopy. Six patients (2.6{\%}) in the cystoscopy group and 5 (1.4{\%}) in the no-cystoscopy group had ureteral injuries (odds ratio, 1.92; 95{\%} confidence interval [CI], 0.58-6.36). This association was further attenuated after adjusting for the propensity to undergo cystoscopy (odds ratio, 1.31; 95{\%} CI, 0.19-9.09). Four injuries detected cystoscopically were managed intraoperatively. Adjusted mean-predicted costs for patients undergoing cystoscopy were $10,686 (95{\%} CI, $7500-$13,872) versus $10,217 (95{\%} CI, $6894-$13,540). In the no-cystoscopy group, patients with ureteral injury had a median increase in creatinine level of 0.2 mg/dL, whereas patients without injury had a median decrease of 0.1 mg/dL (P < 0.001). Conclusions The level of selection for cystoscopy did not significantly increase the mean predicted costs for patients. Reliance on postoperative creatinine level to detect ureteral injury, while highly sensitive, is limited by a low positive predictive value and variable range.",
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AB - Objectives The aim of this study was to determine the utility of intraoperative cystoscopy in detecting and managing ureteral injury among women undergoing vaginal hysterectomy. Methods We performed a secondary analysis of a retrospective cohort study of 593 patients who underwent vaginal hysterectomy for benign indications, with or without additional pelvic floor reconstructive surgery, from January 2, 2004, through December 30, 2005. A logistic regression model determining the propensity to undergo intraoperative cystoscopy was constructed. Comparisons of ureteral injury and cost between patients with and without cystoscopy were adjusted for the cystoscopy propensity score. We further explored the feasibility of using perioperative change in creatinine level to detect ureteral injury. Results In total, 230 (38.8%) of 593 patients underwent cystoscopy. Six patients (2.6%) in the cystoscopy group and 5 (1.4%) in the no-cystoscopy group had ureteral injuries (odds ratio, 1.92; 95% confidence interval [CI], 0.58-6.36). This association was further attenuated after adjusting for the propensity to undergo cystoscopy (odds ratio, 1.31; 95% CI, 0.19-9.09). Four injuries detected cystoscopically were managed intraoperatively. Adjusted mean-predicted costs for patients undergoing cystoscopy were $10,686 (95% CI, $7500-$13,872) versus $10,217 (95% CI, $6894-$13,540). In the no-cystoscopy group, patients with ureteral injury had a median increase in creatinine level of 0.2 mg/dL, whereas patients without injury had a median decrease of 0.1 mg/dL (P < 0.001). Conclusions The level of selection for cystoscopy did not significantly increase the mean predicted costs for patients. Reliance on postoperative creatinine level to detect ureteral injury, while highly sensitive, is limited by a low positive predictive value and variable range.

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